The trials of trials: RCTs to assess causal questions about social interventions

Increasingly, researchers have been engaged in the conduct of experimental studies to assess the impact of social conditions on health outcomes. These studies adhere to high randomized controlled trial (RCT) methods. Although the outcomes of these RCTs may well reflect the true causal impacts of interventions, the studies commonly have design challenges that make them less than optimal to evaluate the causal nature of these relationships. Adherence to the standard biomedical models for RCTs poses some inherent challenges to social experiments: ethical, related etiologic periods and to implementation. Initially, we believed that RCTs of social interventions had unique features, and it was these conditions that posed the greatest challenges to their conduct. Upon more reflection, the challenges we face are shared with many RCTs across both biomedical and social interventions.

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